Effect of metformin on the survival of patients with ALL who express high levels of the ABCB1 drug resistance gene

• Published in: Journal of translational medicine 2018-09, Vol.16 (1), p.245-245, Article 245
• Main Authors: Ramos-Peñafiel, Christian, Olarte-Carrillo, Irma, Cerón-Maldonado, Rafael, Rozen-Fuller, Etta, Kassack-Ipiña, Juan Julio, Meléndez-Mier, Guillermo, Collazo-Jaloma, Juan, Martínez-Tovar, Adolfo
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Acute lymphoblastic leukemia (ALL); Acute lymphocytic leukemia; Adolescent; Adult; Analysis; Antidiabetics; Apoptosis; ATP binding cassette subfamily B member 1 (ABCB1); ATP Binding Cassette Transporter, Subfamily B - metabolism; Breast cancer; Cancer; Cancer therapies; Care and treatment; Chemotherapy; Diabetes; Drug resistance; Drug Resistance, Neoplasm - genetics; Female; Gene expression; Gene Expression Profiling; Genetic aspects; Glycoproteins; Humans; Immunophenotyping; Kaplan-Meier Estimate; Kinases; Leukemia; Leukocytes - cytology; Lung cancer; Lymphatic leukemia; Male; Medical prognosis; Melanoma; Metabolism; Metastasis; Metformin; Metformin - therapeutic use; Middle Aged; Neoplasm Recurrence, Local; Odds Ratio; Pancreatic cancer; Patient outcomes; Patients; Polymerase chain reaction; Population studies; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prognosis; Prospective Studies; Proteins; Quantitative real-time polymerase chain reaction (qRT-PCR); Remission; Remission Induction; Risk factors; Survival; Survival analysis; Systematic review; Transcription; Treatment Outcome; Treatment resistance; User groups; Young Adult
• ISSN: 1479-5876; 1479-5876
• DOI: 10.1186/s12967-018-1620-6

In acute lymphoblastic leukemia (ALL), high ABCB1 gene expression has been associated with treatment resistance, which affects patient prognosis. Many preclinical reports and retrospective population studies have shown an anti-cancer effect of metformin. Therefore, the objective of this study was to assess the effect of metformin on the treatment regimen in patients with ALL who exhibited high levels of ABCB1 gene expression and to determine its impact on overall survival. A total of 102 patients with ALL were recruited; one group (n = 26) received metformin, and the other received chemotherapy (n = 76). Measurement of ABCB1 transcript expression was performed using qRT-PCR prior to treatment initiation. Survival analysis was performed using Kaplan-Meier curves. The impact of both the type of treatment and the level of expression on the response (remission or relapse) was analyzed by calculating the odds ratio. The survival of patients with high ABCB1 expression was lower than those with low or absent ABCB1 gene expression (p = 0.030). In the individual analysis, we identified a benefit to adding metformin in the group of patients with high ABCB1 gene expression (p = 0.025). In the metformin user group, the drug acted as a protective factor against both therapeutic failure (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.0037-1.53) and early relapse (OR 0.05, 95% CI 0.0028-1.153). The combined use of metformin with chemotherapy is effective in patients with elevated levels of ABCB1 gene expression. Trial registration NCT 03118128: NCT.